“I used to have an arch, and now my arch seems to be falling!” You may have heard this complaint from your friends or family, or you may be experiencing this yourself, right now. “Fallen arches” or Adult Acquired Flat Foot are two common names for what is known as Posterior Tibial Tendon Dysfunction (PTTD).

What was once a disabling condition, is now very treatable, as long as it is diagnosed early. Conservative treatment, including rest, stretching and strengthening exercises, foot massage, and anti-inflammatory medication are important and required. More important are orthotics and supportive foot wear, which should be used on a daily basis. Some of the best shoes for posterior tibial tendon dysfunction all have two features in common:

They all have a rigid sole, and a slight heel.

Symptoms & Causes of PTTD​

The Posterior Tibial Tendon (PT Tendon) is one of the most important tendons in your foot and ankle. It is a tendon that runs along the inside of your ankle, and down into your foot. The PT Tendon is important in maintaining and supporting your arch height. The tendon acts like a fulcrum, helping to hold your arch up, and creating a supination force (an inward rotation of your foot, which helps with stabilizing the foot and ankle).

PTTD is most common in women over 40, specifically menopausal and post-menopausal women are more likely to acquire PTTD. PTTD also occurs in older adults, overweight or obese patients, Diabetics, and can happen with a limb length discrepancy, where one leg is longer than the other.

Less commonly, PTTD occurs in athletes, when they have an overuse injury of the PT tendon. This happens when an athlete engages in high impact activities, which puts increased stress and tension on the tendon, which causes inflammation, and dysfunction of the PT tendon.

Diagnosis​

If you do start to notice that your arch is falling, or you have pain in the inside of your ankle, it is important to get it examined by your doctor. Many times, the clinical examination alone can determine if you have a PTTD.

An exam called the “one leg heel raise” is done, where the patient is asked to stand on the affected leg, and stand up on his/her tip toes. Many people have pain while doing this exercise, or some may not be able to do it at all. This is a sure sign of a PTTD.

To get a more accurate assessment of the precise location of the tear or inflammation, a diagnostic ultrasound or an MRI may be done. At this point the doctor may tell you the Stage of PT Tendon Dysfunction that you have. If caught early at Stage I or Stage II, the PTTD can be treated and the pain alleviated.

4 Stages of PTTD​

There are 4 stages of PTTD. The classification by Johnson and Strom (1989) is the most commonly used.

In Stage I, the tendon is inflamed, but there are little if any noticeable changes to the tendon, and the tendon is intact.

By Stage II, there is a visible “fallen arch” deformity of the foot, with increased pain and inflammation.

Stage III is an advanced foot deformity, with arthritis, and a very visible “fallen arch”.

Finally, at Stage IV, the ankle joint has started to get affected and there is pain and arthritis in the ankle joint.

Orthotics​

One of the important treatment measures are orthotics or inserts for shoes. Custom molded orthotics are undoubtedly the best, since they are customized to each person’s individual foot, and their specific deformity. However, pre-fabricated orthotics are also available, which will help.

The Sole Softec Ultra-U-Arch support inserts, as well as the Superfeet Black Premium Insoles offer the next level of orthotics or inserts which will aid in supporting the posterior tibial tendon thereby alleviating pain and further inflammation.

The Best Running Shoes for PTTD​

Some of the best shoes in the market today for running are designed specifically to stop pronation, and to prevent excessive stress to be placed on the PT tendon.

Some of the best running shoes for Posterior Tibial Tendon Dysfunction in the market are:

1. Saucony Redeemer ISO Running Shoe, Women’s and Men’s.

Saucony has the designation of being the oldest running shoe. Saucony was started on the Banks of Saucony Creek, in Kutztown, PA, in 1898. They also manufactured their shoes solely in the United States, until 1994.

This particular shoe, the ISO Running shoe has a rubber sole, for shock absorption, and a slight heel raise of 29mm, as well as a power grid midsole, providing increased support in the arch. The best part, is that it does accommodate orthotics, either custom or pre-fabricated.

2. New Balance Women’s and Men’s 1540v2 for PTTD.

New Balance is one of the only shoe companies that still solely manufactures its shoes in the United States. Because of that, the prices of the shoes are a bit higher. New Balance was founded in Boston, MA in 1906.

The New Balance 1540v2 has a rubber sole, for shock absorption, and an Acteva Lite midsole. Many runners appreciate this type of midsole, as it is lighter than the standard foam material, yet it delivers the same amount of support to the arch.

3. New Balance Women’s and Men’s 990v4 for PTTD

Another popular running shoe, the 990v4 has a unique feature of an Encap Midsole, as well as an Encap Heel. An Encap is made from an Eva midsole, which is a type of closed cell foam which creates a unique cushioning effect, without taking away from the stability it provides in the arch. This is important for runners who run on varying terrain, and uneven ground. This shoe also has a rubber sole for shock absorption.

The Best Dress Shoes for PTTD​

While shopping for dress shoes with a PTT Dysfunction, there are two important factors to keep in mind; the stiffness of the shoe, as well as the cushioning it provides. Stiffness means that there should be no bending, and no twisting when stress is placed on the sole of the shoe. However, you do need to look for cushioning in the shoe as well. The cushioning will provide for shock absorption. Leaving either the stiffness or the cushioning out will cause pain and fatigue of the foot, exacerbating the Posterior Tibial tendonitis.

Some of the best dress shoes for Posterior Tibial Tendon Dysfunction in the market are:

1. Ecco Shoes: Ecco Men's Oxford

These shoes are manufactured in Denmark, and was founded in 1963. In 1990, Ecco formed an organization in the United States and since then, the United States has become the largest market for Ecco Shoes.

Ecco Men’s Oxford, which has a 1” heel, which is important to have since a heel will remove the pronation forces on the foot and decrease the pain that those pronatory forces will have on the Posterior Tibial tendon. This Oxford has a rubber sole for shock absorption as well as a polyurethane outsole for traction while walking on all types of terrain.

2. Cole Haan Shoes: Cole Haan Shoe for Men

These shoes had its start in Chicago, Illinois in the United States in 1928. They have become globally recognized and are sold across the world. Cole Haan Shoe for Men, which has a 1” heel, important for Posterior Tibial Tendon Dysfunction. It is also very easy to slip into, with no hassle of laces, and it has a rubber sole for shock absorption.

3. Clarks Shoes for Women

The Clarks shoe is internationally recognized, and was founded in Somerset, England in 1825.

Whatever your style in dress shoes for women, Clarks has it, and they seem to do it very well. Whether you like the Clarks Women’s Dress Pump, the Slip-on Loafer, or the traditional Mary Jane pump, they all have some important features in common which will help to support a painful PTT Dysfunction. They all have a 2-3” heel, which is again important in alleviating the pronation forces on the foot, and they all have a rubber sole, so important for shock absorption.

4.Dansko Shoes: Minnette Shoe for Women

The Dansko shoes were founded in 1990 by a husband and wife team in West Grove, Pennsylvania, USA. They are now sold in Australia, New Zealand, Asia, and North America.

The Dansko Minette Shoe is a Mary Jane style dress shoe which is 2” in heel height, important in minimizing the pronation forces. It also has a removable arch support and memory foam for cushioning. It also has an integrated insole, providing stability and support.

The Best Flip Flops for PTTD​

As with dress shoes, while shopping for flip flops, keep in mind that a slight heel is ideal, as well as a rigid sole. Both of these provides for the control and stability that your foot needs with PTT Dysfunction.

Some of the best flip flops for Posterior Tibial Tendon Dysfunction in the market are:

1. Clarks Flip Flops: Specifically the Arla Marina Women’s Flip Flops. Its important to note that these flip flops have a heel height of 1.5 inches, almost 2 inches, which is great for stabilizing the PTTD foot. A unique feature is its flexible EVA outsole, a closed cell foam providing stability as well as cushioning.

2. The Gekadong Men’s Sandal is very popular and provides support, with a 1” heel, and is also “water friendly”.

3. The Vionic Unisex Wave Sandal, both for women, and men has a rubber sole for cushion and a 1” heel.

Conservative Treatments​

In recent years, more focus has been put on conservative treatments for PTTD. Many researchers and doctors alike have found that if caught early, PTTD can be treated and the symptoms resolved. More emphasis has been placed on conservative treatment options, rather than surgical, especially if the diagnosis is made in the first two stages of PTTD.

Conservative treatments include Orthotics or Inserts, which go into the shoes to support the arch and the PT tendon. Another conservative treatment is bracing, i.e. the Richie Brace which helps to support the entire ankle joint, as well as the medial arch, providing strength to the entire course of the PT tendon. Finally, footwear is extremely important for stability while ambulating on various types of terrain. A good pair of shoes will prevent further progression of the PT tendonitis, by providing support, shock absorption and decreasing the pronation forces on the foot

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The human foot is made up of 26 bones, and if you include the sesamoids, each foot actually has 28 bones. The sesamoids are tiny little bones under the 1^st Metatarsal head, which sit on the bottom of the foot. The sesamoids are about the size of a chickpea (garbanzo bean). And, like the chickpea, the sesamoid has a groove on each bone to allow for the FHB (Flexor Hallucis Brevis) Tendon to easily glide over the 1^st Metatarsal head. This easy gliding motion makes for a very efficient tendon, and it also provides for a fulcrum over which the tendon runs, like a pulley system. This pulley system is essential for the big toe, so that the tendon won’t tire easily.

There are many causes for sesamoiditis, including high impact activities that can lead to painful sesamoiditis; shoe gear, and genetics which can play a big role. Prevention, which involves wearing the right shoes, is key to avoiding sesamoiditis all together; however, once sesamoiditis has been diagnosed, it is equally important to find the best shoes for sesamoiditis.

Sesamoiditis is actually the inflammation of the entire Sesamoid-Tendon complex. Not only do the sesamoids themselves get inflamed, but the FHB tendon and the associated ligaments surrounding the sesamoids are also inflamed. There is a ligament called the inter-sesamoidal ligament which connects the two sesamoids together. Often with a sesamoid injury, this intersesamoidal ligament either ruptures or is torn or injured.

Non-surgical treatment options are recommended for Sesamoiditis without a fracture involvement. Rest, Ice, and Shoes are conservative treatment options. One other non-surgical treatment option is orthotics, or custom molded inserts, which go into your shoes and help to shift the weight from the sesamoids to the other metatarsal heads.

A custom orthotic with a “reverse Morton’s Extension” is essential. The reverse Morton’s Extension will put more pressure on the other metatarsals, and less pressure on the 1^st MT head and the sesamoids. The orthotic should also conform to the entire bottom of the foot; this is important so that the weight gets distributed evenly across the bottom of the foot.

Although not common, sesamoid fractures do occur. It is important to have an XRay done to rule out a sesamoid fracture. If there is a fracture, it can heal with just rest and immobilization. However there are instances when the fracture will not heal. When that happens, it is called a non-union and can be very painful. A non-union can be treated with surgical removal of the sesamoid, which has had good results, alleviating pain with only minimal complications.

What to Look for in Shoes to Help with Sesamoiditis

While looking for shoes, make sure that you go shopping at the end of the day, as your feet will swell slightly by the end of the day, and this will affect your shoe size.

1. The best shoes for sesamoiditis are ones which do not bend much at the Metatarsal area, or the forefoot. If the shoes do bend at the forefoot, this will exacerbate the pain in the Sesamoid-Tendon complex, creating more pain and inflammation.

2. Make sure the shoe that you choose has a wide toe box. This wide toe box will ensure more room at the toes, helping to limit pressure on the sesamoids, which will decrease inflammation.

3. Shoes which have a “zero heel to toe drop” is important, so as to allow the heel and the ball of the foot to be on the same plane. This will allow the arch of the foot to take on more pressure, distributing the pressure evenly to the entire foot.

4. The shoe should be light weight, and have increased shock absorption, and cushioning. The shoe should also be deep enough so that it can accommodate a custom orthotic.

5. Be sure to stay away from heels. Heels will increase pressure on the 1^st metatarsal head, and will shift the entire body weight on to the front of your foot, increasing the sesamoid pain. For women, especially, this can be a hard task to find a good dress shoe, that is also a comfortable shoe for sesamoiditis. The Clark’s Women’s Wave Cruise, Mary Jane dress shoe maybe a good option to accommodate the sesamoiditis pain. Although, this shoe has a very small heel to toe drop, it still has good cushioning, and a rubber sole, making it a good option for a women’s dress shoe for sesamoiditis.

The Best Athletic Shoes for Sesamoiditis​

Here are some of the best athletic shoes to choose from:

1. New Balance Men's 990V4 Running Shoe

This running shoe has a rubber outsole and an EVA Core heel, providing for increased shock absorption and cushioning. The New Balance shoes are also deep, and can accommodate for orthotics. The men’s New Balance is a good running shoe for sesamoiditis. The women’s version of the same shoe has a 12mm heel to toe drop, which may not be ideal for sesamoiditis.

2. Merrell Women's Bare Access Arc 3 Trail Running Shoe

This trail running shoe has a zero heel to toe drop, ideal for sesamoiditis, as it decreases the pressure placed on the 1^st Metatarsal head and the sesamoid complex. There is also extra toe and heel cushion incorporated into the shoe. This shoe is one of the best women’s sneakers for sesamoiditis.

3. Mizuno Men's Wave Creation 17 Running Shoe

This running shoe is made from all synthetic material, and therefore, it is a vegan shoe. It has forefoot cushioning, a midfoot wrap, and an infinity wave bounce back heel. It also has a removable insole, so custom molded insoles can be used.

The Women’s Mizuno Wave Creation 17 Running Shoe is just as good.

4. Vibram KSO Evo Cross Training Shoe in Men's & Women's

This barefoot cross trainer has a zero heel to toe drop. However, since it is a barefoot shoe, it also does not have much cushioning and will not accommodate orthotics. This is best for sesamoiditis pain which is just starting. This shoe will alleviate the pain on the sesamoids, because of its zero heel to toe drop, however it has only a rubber outsole for cushioning and will not be good for sesamoiditis which has progressed and is already very painful.

5. Altra AFM1739F Men's Paradigm 3 Road Running Shoe and the Altra Women's Paradigm 1.5 Running Shoe

This is good running shoe for both men and women who have sesamoiditis. This shoe has a zero heel to toe drop, as well as plenty of cushioning with dual layer EVA, as well as shock absorptive outsole.

In Summary​

The best shoes for Sesamoiditis overall are the Altra AFM1739F Paradigm 3 Road Running Shoe for Men and the Altra Women’s Paradigm 1.5 Running Shoe for Women. They both have the zero heel to toe drop, as well as cushioning, and shock absorption. And, they have a sole that is not too flexible at the forefoot, and can accommodate orthotics.

If you do feel like you have pain in your big toe, especially when you move it up and down, you may have sesamoiditis. It is important to have your foot examined, to determine if you have sesamoiditis, and to make sure you do not have a sesamoid fracture.

REFERENCES:

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In recent years, there has been a trend toward more natural treatments to cure medical problems. Plantar Fasciitis, or Heel pain is the inflammation of the plantar fascia of the foot. The plantar fascia is a band of fibrous tissue that runs along the plantar, or bottom of the foot, extending through the whole length of the foot. The fascia originates at the heel bone, and enters into the ball of the foot.

Each time the foot moves, while walking, running or exercising, the fibers glide over each other. When these fibers are stretched beyond their limit, some fibers will partially tear, causing pain and inflammation. If left untreated, this chronic stretching, and tearing of the fascia will ultimately lead to chronic plantar fasciitis, or heel pain, and may eventually lead to the development of heel spurs.

The Best Supplements to Take for Plantar Fasciitis​

Some of the best supplements for Plantar Fasciitis include: Turmeric, Magnesium, Pantothenic Acid (Vitamin B5), Ascorbic Acid (Vitamin C), and Bromelain.

BROMELAIN:

Bromelain is a mixture of enzymes found in the core and stem of the pineapple. Pineapples are also filled with other vitamins, including Vitamin C, Vitamin B1, Potassium, and Manganese, however Bromelain is the most sought after. Bromelain was first isolated from the pineapple core in 1891, and Bromelain supplements were first created in 1957.

The pineapple was native to South America, and was brought to Europe and the far east by Spanish explorers. Today, Costa Rica, Brazil and the Philippines are the greatest producers of the pineapple.

There are two ways to ingest Bromelain. One way is by juicing the stem or the core of the pineapple, and the other way, is by taking a Bromelain Supplement. The supplement comes in 500mg capsules and should be taken twice a day, as a treatment for inflammation, or plantar fasciitis.

Bromelain, or the Pineapple has been using for centuries as a great natural anti-inflammatory.

VITAMIN C:

Vitamin C is also called Ascorbic Acid, and is important in the production of collagen. Collagen is a key component in the development of tendons, ligaments and even blood vessels. Although Vitamin C is found in many foods, including Melons, Citrus Fruit, Broccoli, Tomatoes, and Green Peppers, taking an added Vitamin C Supplement, can help to reduce inflammation.

Vitamin C Supplements are now made with Bioflavanoids, which help to make the Vitamin C more bioavailable, and more readily absorbable by the body. The Vitamin C Supplements come in 1000mg tablets, and have a non-GMO guarantee.

VITAMIN B5:

Vitamin B5, known as Pantothenic Acid is a water soluble vitamin. “Pantothen” is a Greek word meaning “everywhere”. True to its name, Vitamin B5 is actually everywhere, in almost all foods, in small amounts. Vitamin B5 is used by the body’s adrenal glands to produce Cortisol, which is a natural anti-inflammatory, and can be used to treat plantar fasciitis effectively. Some foods high in Vitamin B5 include sunflower seeds, Avocados, Portobella Mushrooms, Salmon and Eggs.

B12, another B Vitamin, has been found to actually cause Plantar Fasciitis. Interestingly, an FDA Study has found that women over 60 years of age, who take Vitamin B12, have a 90.5% chance of having plantar fasciitis symptoms, especially if they take Methotrexate in conjunction with the Vitamin B12.

MAGNESIUM:

Magnesium is a supplement to treat plantar fasciitis, but it does not decrease inflammation directly as the other supplements do. Magnesium itself helps to support healthy bones, and teeth; it also helps to support nerve, heart and muscle function.

However, Magnesium plays another important role. It helps to absorb Calcium. In chronic plantar fasciitis, the body will start to deposit calcium at the area of the most inflammation and the most pain. This is usually at the insertion of the plantar fascia, at the heel. This deposition of Calcium will eventually lead to a heel spur formation.

By taking magnesium supplements, the body is now able to absorb the extra calcium that is deposited at the heel. This improves healing by decreasing the formation of heel spurs and decreasing scar tissue formation. The Magnesium Tablet usually comes in approx. 250mg, and can be taken once daily with food.

TURMERIC:

Turmeric is widely known as one of the many superfoods on our planet. Turmeric is used widely for the treatment of many ailments. Turmeric is also known as curcumin, which is also its active ingredient. It has potent anti-inflammatory properties, and is one of the natural remedies to alleviate plantar fascia pain.

Turmeric is a Rhizome (a stem that grows underground), and is in the ginger family. The stem of the turmeric plant is dried and ground down to a yellow powder, which we are more familiar with. Turmeric can be made into capsules, powders, teas as well as a paste, all of which can aid in decreasing the pain of plantar fasciitis.

The Turmeric Capsule contains 10mg of black pepper to make the turmeric more bioavailable and improve its absorption into the body.

Turmeric Powder can be used to create a paste. Just mix the powder with Olive Oil or Coconut Oil, to create a pasty consistency. This paste can be applied directly to the skin to aid in the anti-inflammatory process.

In Summary​

These 5 supplements are a more holistic approach to treating plantar fasciitis, and are some of the best supplements for the treatment of plantar fasciitis. Typically, treatments of plantar fasciitis in the past included anti-inflammatories, such as Motrin or Naprosyn. However, “The Annals of Internal Medicine” in 2012 found that Plantar Fasciitis is more degenerative rather than Inflammatory; and that anti-inflammatories are only recommended for the initial pain, and not as a long term treatment. This finding throws a new light on supplements and vitamins to help treat fasciitis; treatments that already exist in nature

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Fortunately, over 90% of plantar fasciitis (inflammation of the plantar fascia) can be treated with conservative therapy, which does not require surgery. Much of the conservative and natural treatment of plantar fasciitis consists of orthotics, and supportive foot wear. Having a supportive arch is vital in choosing the best flip flops for plantar fasciitis.

Do Flip Flops Help or Harm Plantar Fasciitis?​

Flip flops are generally not considered the best treatment modality for plantar fasciitis, however, a study in the BMC Musculoskeletal Disorders in 2016, Nov 11 did find that:

Some studies show the negative effects of wearing flip flops. A study done by Auburn University in Alabama showed that flip flop wearers take smaller steps than if those same people wore more supportive shoes, or sandals with a back strap around the heel. This smaller stride length can cause more instability in gait, causing increased tripping and stumbling while walking.

In the Ireland Journal of Med. Science, they found that wearing flip flops may “increase the risk of tripping over uneven ground” due to the change in the kinematics of the foot. In addition to shorter stride length, the strap of the flip flop is a cause for concern. The strap is the only thing that is holding the foot to the shoe; therefore, excessive walking can result in friction blisters, increased pain, and a great potential for infection.

Flip flops with no arch support can, and will change the posture of the person wearing it and can stretch out the Achilles tendon. Changing the posture for a period of time will put more stress on the back, leading to back pain, and continuous strain on the Achilles tendon, which can lead to Achilles tendonitis, or inflammation of the Achilles Tendon. A chronic plantar fasciitis can also lead to the development of painful heel spurs.

Although there are many causes for concern with wearing flip flops, many people still enjoy the breathability of the flip flop sandal especially in warmer climates, and near the beach. Many people also enjoy the convenience of being able to slip the flip flop on and off with ease. Having a flip flop available is still better than walking barefoot, especially with plantar fasciitis.

Keeping this in mind, many companies have come up with flip flops that are more supportive, and ones that can be alleviate the pain on plantar fasciitis.

What to Look for in Choosing the Best Flip Flops:

1. Good arch support which is essential in unloading the heel, and distributing the body weight evenly across the whole plantar aspect of the foot.

2. Heel cup depth – This depends on the foot type, and the “feel” of the sandal on your foot. With a high arch foot type, too deep of a heel may put more pressure on the heel, causing more pain.

3. A comfortable foot strap that not only feels secure on your foot, but secures your foot to the flip flop. If the flip flop is not secure, and snug on your feet, they are liable to “flip” right off your foot while you are walking, especially if you increase your pace even a little. You may even hear the “flop” noise when you walk if your flip flop is not secure enough on your foot.

The Best Flip Flops for Plantar Fasciitis​

Some of the best flip flops and sandals for plantar fasciitis and heel spurs are:

1. Clark's Women's Breeze Sea & Brinkley Keeley Flip Flops​

Clark’s Women’s Sandals seem to do well across the board. The two that stand out the most are The Women’s Breeze Sea Flip Flops and the Women’s Brinkley Keeley Flip Flops. They both come in various colors. They have a 1.18” heel height, a rubber sole which makes it stable on most surfaces, and an adjustable thong strap with a hook and loop closure. This adjustable thong strap can make a huge difference with how secure the shoe is and feels on the foot.

2. Orthaheel​ Tide Thong Sandal

The Orthaheel Tide Thong Sandal for women are designed by Podiatrists, and have arch support, which helps with increasing knee and back support as well.

3. Sole Sport Flip Flops

The Sole Sport Flip Flops for Men have a soft heel support, a forefoot cushion, as well as arch support. They are light weight and waterproof, which is good for all types of environments.

4. Chaco Flip Eco Tread​

Chaco is another great brand for men, specifically the Chaco Flip Eco Tread. This company calls their flip flops, “The Flips without the Flop”. Their foot bed is polyurethane, and they provide good arch support, so they are great for taking long extensive walks. They are also slip resistant. The downside is that they are not water resistant, and they do not do well in water.

5. Olukai Ohana for Men and Women​

The Olukai Ohana is a good flip flop for men and women. They provide good arch support, and have an EVA midsole. These flip flops also have a lifetime warranty on some parts. They also use 0% animal products, a unique feature that is a great selling point for this company.

6. Unisex Oofos Sandals​

Unisex Oofos Sandals come is various colors, and have a 1” heel which limits pronation. It has the Oofoam, which absorbs 37% more shock than the normal foam material. It decreases stress on the feet, helps with sore feet, and decreases pain in the knees and lower back, with its medial arch support. The company markets the sandal as a post-work out recovery shoe. Having arch support and the 1” heel is a big advantage.

7. Dawgs Women's and Men's​

Dawgs women’s and men’s, which offers “fun and funky” patterns, and variations in style and design. They have an arch support, with a comfortable massaging foot bed. They are also light weight and easy to clean, even if they get wet. The Dawgs are durable and resilient, and nice option for warm weather.

8. Birkenstock Arizona vs Birkenstock EVA (Unisex)​

These sandals have done well for many years. The original Birkenstock, the Arizona, Mayani is one of the many types that is made from cork and latex, as opposed to the EVA style which is made from EVA. The main difference is that the Birkenstock EVA can get wet, versus the other types of Birkenstock that cannot get wet, or the cork and leather will not last. However, a benefit of the cork material, is that it shapes to your foot over time, and gets more and more comfortable as you start to break it in.

The German made Birkenstocks are comfortable and are very popular. They all have a Metatarsal Ridge (also see the best sandals for metatarsalgia), at the front of the shoe, which is an elevated area or a ridge that slightly elevates the toes, engaging the foot muscles and promoting a natural gait pattern. They all also have a deep heel cup and stable arch support, and provide for good traction, as they have a rubber outsole.

Conclusion​

While choosing the best flip flops for plantar fasciitis, keep in mind that you still need to try the flip flops on, and really feel the sandal on your foot. It should feel good on your feet while you are walking, and should alleviate the pain in your heel. By choosing a flip flop with a good arch support, a heel cup that is soft, and a foot strap that is snug, you may be able to alleviate your heel pain, and still have a stylish sandal to wear in warm weather. Don't forget to also check out the top rated shoes for plantar fasciitis.

References:

1. https://www.ncbi.nlm.nih.gov/pubmed/20660875

2. https://www.ncbi.nlm.nih.gov/pubmed/27835963

3. https://www.ncbi.nlm.nih.gov/pubmed/25279003

4. https://www.ncbi.nlm.nih.gov/pubmed/18820040

5. https://www.ncbi.nlm.nih.gov/pubmed/26902474

6. https://www.ncbi.nlm.nih.gov/pubmed/24196492

7.  DeMaio, M., Paine, R., Mangine, R. E., & Drez, D. (1993). Plantar fasciitis. Orthopedics, 16(10), 1153-1163.

8. Buchbinder, R. (2004). Plantar Fasciitis. New England Journal of Medicine, 350(21), 2159-2166. doi:10.1056/nejmcp032745.

9. Wolgin, M., Cook, C., Graham, C., & Mauldin, D. (1994). Conservative Treatment of Plantar Heel Pain: Long-Term Follow-Up. Foot & Ankle International, 15(3), 97-102. doi:10.1177/107110079401500303.

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